Question 1

Are you taking new patients?

Accepted Answer

I am taking new patients on a limited basis. I also have a waiting list and have  3-4 cancellations a week and work new patients into these time slots. I screen all patients for best fit based on the patient’s needs and my current caseload. When I am not able to take a new patient, I refer the person to a colleague, whom I have a long history with.

Question 2

How long will it take for me to get well or get better?

Accepted Answer

That depends on a host of factors. Some of these factors include: 
·       The presenting problem
·       Chronic or acute illness 
·       Supports systems
·       Physical health
·       Innate strengths 
·       Context  
·       Spiritual values

Most people do want to get better as quickly as possible, and I often remind patients to judge their growth by direction and not time. It’s important to refrain from comparing yourself to your perspective of other people’s progress, as the factors are never going to be the same.

Additionally, many patients alter their goals as they progress. For example, a person might come to get help with depression or anxiety and improve in that area. Then they may turn their direction toward changing the life circumstances that contributed to creating the problem to begin with. This refers to what is called first-order and second-order change.

First-order change refers to symptom relief that does not address the underlying problem. People do improve with first-order change and for them that may be enough. For example, learning and applying a skill called Language of Awareness (LOA) is first-order change.

Second-order change goes deeper and alters the underlying cause of a problem. The choice about first-order or second-order change is a personal decision. This decision is usually based on pain. When the suffering from repeating unhealthy patterns outweighs the pain of psychological growth, people will often choose second-order change. It’s more complex and deeper work.

Thus, the shortest answer to the question of how long it will take to get better is, “It depends on your definition of better.”

Question 3

Do you bill my insurance?

Accepted Answer

I accept the more common insurances and yes, we bill your insurance directly. Some insurances are paying dismally these days, and some insurances are creating higher out of pocket expenses. We always screen before accepting a new patient and encourage you to know exactly what your out-of-pocket expenses are. This depends on your co-pay, your deductible,  and limits on psychiatric and mental health benefits.

Question 4

Do you accept Medicaid or Medicare?

Accepted Answer

I do accept Medicaid and Medicare on a percentage basis. I allow a third of my practice to be Medicare and Medicaid patients.

Question 5

Do you accept cash patients?

Accepted Answer

Yes, and the fee is $200 for a 53-minute session or $100 for a 26-minute session. All sessions allow for a few minutes to finish progress notes. Notes must be started during patient sessions and completed during the time allowed at the end of the session. Medication refills must be addressed during the sessions as well.

Question 6

What are your fees that are not paid for by insurance?

Accepted Answer

Some of the fees  that are not covered include the insurance deductible, the insurance copay, forensic work, record preparation for life insurance, disability applications, prior authorization that take longer than normal and special requests letters that are not covered by insurance.

Question 7

What is the fee if I cancel an appointment without 24-hour notice?

Accepted Answer

I have a firm 24-hour cancellation policy and unfortunately this is necessary. When cancellations are made at least 24 hours in advance, we have time to offer your session to patients from the waiting list. There are 10-15 people on the waiting list.

Monday appointments need to be cancelled by Friday of the previous week. The first time a patient has a no-show or cancels without 24-hour notice, a $50.00 fee is charged. The second time this occurs within a calendar year a $100 fee is charged and the third time a patient does this, they will get a referral letter to another practitioner.

There are true and fortunately rare life-threatening emergencies, and in that case, I will make allowances and waive the charge. Migraines, getting called into work, no daycare, etc. are not life-threatening emergencies. Medicaid does not allow late cancellation or no-show fees. Therefore, with Medicaid, a patient gets one chance. A no-show on the first appointment is not permitted to reschedule.

Question 8

What should I expect at my first appointment?

Accepted Answer

At your first appointment, please be prepared with a medication list and any records you feel are important to be reviewed. We will identify the presenting problem, take a history, and begin to develop our treatment plan. The evaluation process often takes a few sessions to complete. I also want my patients to leave their first session feeling some direction and hope, and therefore want to make that human connection. This is equally important.

So, our first session is not only about completing the history and identifying the problem, but also about forming a relationship. That’s a lot to get done in 53 minutes, so we get right to work. Your time and money are important to you, and I don’t want to waste yours or mine. You are paying for my time, my education, my licensing, and forty years of experience.

Good therapy creates an intimate relationship within therapeutic boundaries. I genuinely care about my patients and that is the part that can’t be paid for. That part is from my heart and my personal commitment to human growth and wellness.

Question 9

What should I expect during therapy?

Accepted Answer

Expect growth. Expect a directional change. Expect to learn the Language of Awareness (LOA). Expect to meet your parts (IFS). Expect for your relationships to change (Boundaries). Expect to feel calmer (Integration), more connected to your “self” and others and more clarity (IFS). Expect to become more aware of your thought patterns (CBT). I could easily continue with this list. You get the idea though that therapy is not simply venting to a listening ear.

I give homework and expect my patients to take home what we are working on in therapy. One hour a week will not create change in your life. What creates the change is integration and application. We work as a team.

At times I observe patients making little progress. In that case we do not keep doing the same thing. As Albert Einstein brilliantly said, “Insanity is doing the same thing over and over and expecting different results.” We change what we are doing.

Question 10

What is kept confidential?

Accepted Answer

HIPAA protects your personal health record and allows for important exceptions. These confidentiality exceptions include: 1.) preventing a serious and imminent threat, 2.) patient treatment, 3.) ensuring public health and safety, 4.) notifying family, friends, and others involved in care.

There is an abundance of misinformation regarding HIPAA protection and what it allows and does not allow. Providers are responsible for using their best judgement regarding protected health information (PHI) and what is and what is not in a patient’s best interest. In my experience, more harm is done by NOT communicating what CAN be communicated for a patient’s best interest. It’s also about trust. I encourage my patients to know their rights and to discuss any concerns with me about privacy.

Question 11

Why isn’t your office open to the public?

Accepted Answer

To protect and preserve patient privacy and confidentiality, the
entrance into the Carlsen Psychiatric Care office is limited to authorized 
patients & business invitees of Dr. Carlsen & Carlsen Psychiatric Care LLC.
Patients & invitees are seen by appointment only. In the case of a psychiatric
emergency, please call 911. Patients or any persons or officials who
need to access the office or need to view or access the office for
regulatory or public health reasons, should please call 605-521-0921
and navigate to the URGENT inbox. This will send an emergency text
to Dr. Carlsen and alert her to address the text immediately.

Question 12

What is the difference between Dr. Carlsen and other mental health professionals?

Accepted Answer

There are significant differences about me and the care I offer. I am going on year forty of practicing in the mental health arena as an Advance Practice Nurse. I have witnessed four decades of mental health changes; some good and some not so good. I have extensive training, education and licensing in psychopharmacology, psychotherapy and couples and family therapy. I am trained to provide care throughout the entire lifespan. This range is unique.

I am often asked what my specialties are. With forty years of experience, I have reinvented my specialty several times. Initially I specialized in child and adolescent treatment. I was director of a few programs with this age group. I then pursued more education and added the credentialing and licensing for marriage and family work and advanced supervision.

Then I went back again and added more education in psychopharmacology and the core sciences to expand my expertise. Next, I went for the doctorate. During this time, I was also a director again for two more programs. I taught on the undergraduate, graduate, and medical level. Finally, I went back for post-doctoral work to sit for a second board certification to be able to prescribe through the lifespan. Now I also would like to write and publish more.

There are few practitioners who are blessed with the breadth and depth of knowledge of the psychiatric mental health field that I have. The breadth and depth are a result of four decades of experience, five licenses, two national advanced practice board certifications and outstanding teachers and mentors. I have been truly blessed to have training from some of the most brilliant minds in the field of psychiatry, psychology, family therapy and law. I am grateful for these opportunities and value paying forward what I have been able to learn and accomplish to benefit my patients.

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